Abstract Details

Title Thrombectomy for the Treatment of Large Core Ischemic Strokes: An Updated Systematic Review and Meta-analysis After the Release of the TESLA and TENSION Trials

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P9 - Poster Session 9 (8:00 AM-9:00 AM)

Poster/Presentation
Number 5-001

Objective This study aimed to evaluate the safety and efficacy of endovascular thrombectomy (EVT) in large-core acute ischemic stroke (AIS) patients

Background The available evidence supporting the use of EVT in patients with large-core AIS is increasing. Recently, the results of the TESLA and TENSION trials were released. This calls for an updated systematic review and meta-analysis that combines these studies with the prior results of previously published trials

Design/Methods A systematic review was conducted to include randomized controlled trials (RCTs) that compared EVT to medical management (MM) for the treatment of patients with large-core AIS. The outcomes included the modified Rankin Scale (mRS) and mortality at 90 days and rates of symptomatic intracranial hemorrhage (sICH). An mRS of 0-2 and 0-3 were used to define independent and moderate functional status, respectively. Pooled odds ratios (OR) were calculated for shift mRS through the random-effects meta-analyses, while risk ratios (RR) were used for the other outcomes, comparing EVT with MM alone

Results

Out of 2105 documents from title and abstract screening, this study included five RCTs. The odds for a shift to better mRS was higher in the EVT group as compared to the MM alone (OR: 1.46, 95%CI: 1.19-1.79). Furthermore, the use of EVT was associated with more instances of independent (RR: 2.47, 95%CI: 1.87-3.25) and moderate (RR: 1.77, 95%CI: 1.41-2.24) functional status as compared to MM. The rates of sICH were higher in the EVT group (RR: 1.73, 95%CI: 1.01-2.95) than the MM, but there was no difference between the two groups regarding mortality (RR: 0.92, 95%CI: 0.8-1.06). Subgroup analyses based on age, location, window, NIHSS, ASPECTS, core-volume, thrombolysis, and etiology did not yield group differences

Conclusions

Our results confirm the efficacy and safety of EVT for large-core AIS. Identifying patients that might not benefit from EVT need to be studied further.

Authors/Disclosures
Mahmoud Dibas, MD PRESENTER	Mr. Dibas has nothing to disclose.
Mohammad Almajali, MD (University of Iowa Hospital and Clinics)	Dr. Almajali has nothing to disclose.
Malik Ghannam, MBBCh	Dr. Ghannam has nothing to disclose.
Milagros Galecio-Castillo, MD	Dr. Galecio-Castillo has nothing to disclose.
Abdullah M. Al-Qudah, MD (University of Pittsburgh Medical Center)	Dr. Al-Qudah has nothing to disclose.
Farid Khasiyev, MD (SLUCare Academic Pavilion, Department of Neurology)	Dr. Khasiyev has nothing to disclose.
Juan A. Vivanco-Suarez, MD	Mr. Vivanco-Suarez has nothing to disclose.
Aaron E. Rodriguez-Calienes (University of Iowa Hospitals and Clinics)	Dr. Rodriguez-Calienes has nothing to disclose.
Sophie L. Shogren, MD (University of Iowa Hospitals and Clinics)	Dr. Shogren has nothing to disclose.
Fawwaz Husam Al Majali, MD (St. Louis University)	Dr. Al Majali has nothing to disclose.
Albert Yoo (Texas Stroke Institute)	No disclosure on file
Edgar Samaniego, MD, FAAN (University of Iowa Hospital and Clinics)	Dr. Samaniego has received personal compensation for serving as an employee of University of Iowa. Dr. Samaniego has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Terumo Neuro. Dr. Samaniego has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Rapid Medical. Dr. Samaniego has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for J&J Neuro. Dr. Samaniego has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Metronic. Dr. Samaniego has received personal compensation in the range of $0-$499 for serving as a Consultant for iSchemaView. Dr. Samaniego has received personal compensation in the range of $0-$499 for serving as an officer or member of the Board of Directors for Society of Neurointerventional Surgery. Dr. Samaniego has received personal compensation in the range of $0-$499 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Journal of Neurointerventional Surgery.
Amrou Sarraj, MD	Dr. Sarraj has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for AstraZeneca. Dr. Sarraj has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Stryker Neurovascular. Dr. Sarraj has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Stryker Neurovascular. The institution of Dr. Sarraj has received research support from Stryker Neurovascular.
Santiago Ortega Gutierrez, MD (University of Iowa)	Dr. Ortega Gutierrez has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for stryker. Dr. Ortega Gutierrez has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for medtronic. Dr. Ortega Gutierrez has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Medtronic. The institution of Dr. Ortega Gutierrez has received research support from stryker. The institution of Dr. Ortega Gutierrez has received research support from Medtronic. The institution of Dr. Ortega Gutierrez has received research support from Methinks. The institution of Dr. Ortega Gutierrez has received research support from NIH. The institution of Dr. Ortega Gutierrez has received research support from PCORI.

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